CD💚

• Communicable Diseases are Primary Cause of Mortality Gap between Rich and Poor Countries
• Non-communicable diseases account for 59% of all deaths worldwide – estimated to rise from 28m in 1990 to 50m in 2020
• Communicable diseases that account for about 60% of deaths

  • HIV/AIDS
  • Malaria
  • Tuberculosis
  • Measles
  • Diarrheal disease
  • Acute respiratory infection
• Goals of WHO


  • Prevention of disease
  • Prevention of disability and death from infection
  • Prevention through immunization
• Pathogen or causative agent


  Biologic agent (organism) capable of causing disease
• Chain of Infection


  1. Eliminate organism by:

  2. Sterilizing surgical instruments and anything that touches sterile spaces of the body

  3. Using good food safety methods

  4. Providing safe drinking water

  5. Vaccinating people so they do not become reservoirs of illness

  6. Treating people who are ill
• Reservoir


  Any person, animal, arthropod, plant, soil, or substance (or combination of these) in which an causative agent normally lives and multiplies, on which it depends primarily for survival, and where it reproduces in such numbers that it can be transmitted to a susceptible host
• Eliminate reservoirs by:


  1. Treating people who are ill

  2. Vaccinating people

  3. Handling and disposing of body fluids responsibly

  4. Handling food safely

  5. Monitoring soil and contaminated water in sensitive areas of the hospital and washing hands carefully after contact with either
• Portal of exit


  The way the causative agent gets out of the reservoir (body fluid or skin)
• Reduce risk from portals of exit by:

  1. Covering coughs and sneezes with a tissue

  2. Handling body fluids with gloves, then doing hand hygiene

  3. Keeping draining wounds covered with a dressing

  4. Not working when you have exudative (wet) lesions or weeping dermatitis
• Mode of transmission


  Any mechanism by which a pathogen is spread from a source or reservoir to a person
• Eliminate the mode of transmission by:

  1. Hand hygiene

  2. Wearing gloves to minimize contamination of hands and discarding them after each patient

  3. Cleaning, disinfection, or sterilization of equipment used by more than one patient

  4. Cleaning of the environment, especially high-touch surfaces
• Portal of entry


  Hole in the skin that allows the infectious agent to get into the body (mouth, nose, eyes, rashes, cuts, needlestick injuries, surgical wounds and IV sites)
• Protect portals of entry (our own and our patients) by:

  1. Dressings on surgical wounds

  2. IV site dressings and care

  3. Elimination of tubes as soon as possible

  4. Masks, goggles and face shields

  5. Keeping unwashed hands and objects away from the mouth

  6. Actions and devices to prevent needlesticks

  7. Food and water safety
• Susceptible host


  A person or animal lacking effective resistance to a particular infectious agent
• Minimize risk to susceptible hosts by:

  1. Vaccinating people against illnesses to which they may be exposed

  2. Preventing new exposure to infection in people who are already ill, are receiving immunocompromising treatment, or are infected with HIV

  3. Maintaining good nutrition

  4. Maintaining good skin condition

  5. Covering skin breaks

  6. Encouraging rest and balance in our lives
• Symptoms


  Evidence of disease that is experienced or perceived (subjective), subjective changes in body function noted by patient but not apparent to an observer
• Signs


  Objective evidence of a disease the physician can observe and measure
• Syndrome


  A specific group of signs and symptoms that accompany a particular disease
• Incidence

  The number of people in a population who develop a disease during a particular time period
• Prevalence


  The number of people in a population who develop a disease, regardless of when it appeared, refers to both old and new cases
• Classification of Infectious Disease based on Behavior within host

  • Infectious Disease
  • Contagious Disease
• Classification of Infectious Disease based on Occurrence of Disease

  • Sporadic Disease
  • Endemic Disease
  • Epidemic Disease
  • Pandemic Disease
• Classification of Infectious Disease based on Severity or Duration of Disease

  • Acute Disease
  • Chronic Disease
• Classification of Infectious Disease based on State of Host Resistance


  • Primary Infection
  • Secondary Infection
• Stages of Disease


  • Incubation Period
  • Prodromal Period
  • Period of Illness
  • Period of Decline
  • Period of Convalescence
• Mode of Transmission


  The process of the infectious agent moving from the reservoir to the susceptible host
• Types of Contact Transmission

  • Direct Contact Transmission
  • Indirect Contact Transmission
• Recognition of high risk patients

  • Immunocompromised
  • DM
  • Surgery
  • Burns
  • Elderly
• Prevention of Blood/Vector Borne Diseases

  • Chemically treated mosquito net
  • Larvae eating fish
  • Environmental sanitation
  • Anti-mosquito
  • Neem tree (oregano, eucalyptus)
• Dengue Hemorrhagic Fever


  Caused by dengue virus (Flaviviridae) with 4 serotypes, transmitted to a bite of female aedes aegypti mosquito, incubation period 2-7 days
• Vectors of Dengue Fever

  • Aedes aegypti (breeds in water stored in houses)
  • Aedes albopictus
  • Culex fatigans
• Clinical manifestation of Dengue Fever

  • First 4 days – Febrile or Invasive stage
  • 4th – 7th day – Toxic or Hemorrhagic Stage
  • 7th – 10th day – Convalescent or recovery stage
• Classification of Dengue Fever according to severity

  • Grade I – Dengue fever, saddleback fever plus constitutional signs and symptoms plus positive tornique test
  • Grade II – Stage I plus spontaneous bleeding, epistaxis, GI, cutaneous bleeding
  • Grade III – Dengue Shock Syndrome, all of the following signs and symptoms plus evidence of circulatory failure
  • Grade IV – Grade III plus irreversible shock and massive bleeding
• Tourniquet test or Rumpel Leeds Test


  Presumptive test for capillary fragility
• Laboratory Procedures for Dengue Fever

  • CBC
  • Bleeding Parameters
  • Serologic test (Dengue blot, Dengue Igm)
  • PT (Prothrombin Time)
  • APTT (Activated Partial Thromboplastin Time)
  • Bleeding time
  • Coagulation time
• Management of Dengue Fever

  1. Specific Therapy – none

  2. Symptomatic/Supportive therapy

  3. Intravenous Fluids (IVF) with hemoconcentration, 5-7 ml/kg/hr, with shock, 10-30ml/kg in <20mins

  4. Use of Blood/Blood Products (Platelet concentrate, Cryoprecipitate, FFP, FWB, PRBC)
• Nursing Intervention for Dengue Fever

  1. Paracetamol (no aspirin)

  2. Giving of cytoprotectors

  3. Gastric Lavage

  4. Trendelenberg position for shock

  5. Nasal packing with epinephrine

  6. No intramuscular injections

  7. Manage anxiety of patient and family
• Preventive measures for Dengue Hemorrhagic Fever

  • Seek and destroy breeding places
  • Say no to left and right defogging
  • Seek early consultation
• Filariasis


  The disease often progresses to become chronic, debilitating and disfiguring disease since it's symptoms are unnoticed or unfamiliar to health workers